Weak hammering sounds are associated with postoperative subsidence in cementless total hip arthroplasty.

Purpose: The aim of this study was to investigate the relationship between the hammering sound level and the presence of postoperative subsidence.
Methods: The last five hammering sounds during the final-size broaching procedure and during the real stem insertion were recorded and analysed in 95 patients who were operated on by one of seven surgeons using two implants (Trident cup, Accolade II, Stryker; G7 cup, Taperloc Complete Microplasty Stem, Zimmer Biomet). The maximum peak was semi-automatically identified and analysed to determine the maximum C-weighted sound pressure level (LCpeak) of each of the five hammering sounds and the equivalent continuous A-weighted sound pressure (LAeq) of the entire five-sound hammering procedure.
Results: Among the 95 hips, 25 (26.3%) had ≥ 3 mm of postoperative subsidence. Therefore, 125 of 475 hammering sounds (LCpeak) and 25 of 95 hammering procedures (LAeq) in both the broaching procedure and stem insertion procedure were associated with postoperative subsidence. The hammering sound level in both the broaching and stem insertion procedures were significantly weaker in patients with postoperative subsidence than in those without subsidence. Among the seven surgeons, there was intra-surgeon and inter-surgeon heterogeneity with large variance regarding the sound levels. With univariate and multivariate analyses, the hammering sound level was independently associated with postoperative subsidence in the two models.
Conclusion: A weak hammering sound level was associated with postoperative subsidence in THA with a cementless stem. An objective evaluation of the hammering procedure might be useful to decrease the incidence of postoperative subsidence.
Competing Interests: Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee of Juntendo University Faculty of Medicine (E21-0340, 18-March-2022). Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent to publish: The authors affirm that human research participants provided informed consent for publication. Competing interests: Yasuhiro Homma has received payments for speakers bureau/paid presentations from Zimmer Biomet and B.braun Aesclup, research support from B.braun Aesclup and is a consultant to Zimmer Biomet, Kyocera and Teijin, a correspoinding member of International Orthopaedics, a member of the board of subspecialities (Hip arthroplasty), an executive committee member of Asia pacific orthopaedic association and Asia pacific hip society. Tomonori Baba has received royalties and payments for speakers bureau/paid presentations from Zimmer Biomet. Muneaki Ishijima has received payments for speakers bureau/paid presentations from Asahi Kasei Corporation, Astellas Pharma Inc., Amgen K.K., ALCARE Co., Ltd., EA Pharma Co.,Ltd., Viatris Inc., Eisai Co., Ltd., ONO PHARMACEUTICAL CO., LTD., KAKEN PHARMACEUTICAL CO.,LTD., SHIONOGI & CO., LTD., DAIICHI SANKYO COMPANY, LIMITED, Taisho Pharmaceutical Co., Ltd, Mitsubishi Tanabe Pharma Corporation, CHUGAI PHARMACEUTICAL CO., LTD., TEIJIN LIMITED, Eli Lilly Japan K.K., Japan Medical Dynamic Marketing, INC., Nippon Zoki Pharmaceutical Co., Ltd., HISAMITSU PHARMACEUTICAL CO.,INC. and Pfizer Japan Inc., research support from Suntory Wellness Ltd., Stryker Japan K.K, Japan Medical Dynamic Marketing, INC., HISAMITSU PHARMACEUTICAL CO.,INC., Olympus Terumo Biomaterials Corp.,NIHON MATHYS K.K., CellSource Co., Ltd, CHUGAI PHARMACEUTICAL CO., LTD., Zimmer Biomet G.K. OHTA’S ISAN Co., Ltd., Taisho Pharmaceutical Co., Ltd and Aimedic MMT CO., LTD and is an editorial/governing board member of Osteoarthritis and Cartilage, Osteoarthritis and Cartilage Open and Journal of Joint Surgery and Research, a board member/committee appointments for a society of Osteoarthritis Research Society International.
(© 2024. The Author(s) under exclusive licence to SICOT aisbl.)